<form>
  <div class="modal-header">
    <a href="#" class="close" data-dismiss="modal" aria-hidden="true">&times;</a>
    <h3>Report problem</h3>
  </div>
  <div class="modal-body">
    <label for="message">Description of problem</label>
    <textarea id="message" name="message" class="input-block-level" rows="5" />
    <span class="help-block">This message will be sent along with the problem 
    report to the system owner.</span>
  </div>
  <div class="modal-footer">
    <div class="sync-status"/>
    <button type="button" class="btn" data-dismiss="modal" data-loading-text="Cancel">Cancel</button>
    <button type="submit" class="btn btn-primary" data-loading-text="<i class='fa fa-spinner fa-spin'></i> Sending&hellip;">Report</button>
  </div>
</form>
